Journal of Foot & Ankle Surgery最新文献

{"title":"Anatomical variations of the deep plantar arterial arch: surgical implications for partial foot amputations and soft tissue reconstruction.","authors":"Jessica L Morehouse, Jordan M Konstanty, Anna C Cacini, Jamie M Stern, Sara S Sloan","doi":"10.1053/j.jfas.2025.07.012","DOIUrl":"10.1053/j.jfas.2025.07.012","url":null,"abstract":"<p><strong>Background: </strong>The forefoot receives its primary blood supply through the deep plantar arterial arch, typically formed by an anastomosis between the deep branch of the lateral plantar artery and the deep plantar artery. Accurate identification and localization of the deep plantar arch are critical during flap procedures and transmetatarsal amputations to minimize the risk of vascular compromise.</p><p><strong>Purpose: </strong>To assess the anatomical variability, dominance patterns, and location of the deep plantar arch to inform surgical planning and reduce intraoperative vascular complications.</p><p><strong>Study design: </strong>This was a descriptive anatomical study conducted through cadaveric dissection.</p><p><strong>Methods: </strong>Eighty-nine feet from 45 formalin-embalmed cadavers were dissected, with associated arteries traced from their origins and external diameters measured to determine arterial dominance. Distances from key anatomic landmarks were recorded to identify the arch's position within the foot.</p><p><strong>Results: </strong>The deep plantar arch was present in all specimens. Lateral plantar artery dominance and deep plantar artery dominance were each observed in 42.70%, while co-dominance occurred in 12.36%, and medial plantar artery dominance in 2.25%. On average, the arch was located 58.48% of the distance from the calcaneal tuberosity to the distal phalanx. Medial deviation of the arch was found to be influenced by biological sex and the type of vascular dominance.</p><p><strong>Conclusion: </strong>The deep plantar arch demonstrates variability in both its dominance patterns and anatomic position. These findings underscore the importance of preoperative vascular assessment to optimize surgical outcomes and reduce the risk of ischemic complications during forefoot procedures.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency of the combination of Wide Awake Local Anesthesia No Tourniquet (WALANT) and sciatic nerve block for Achilles tendon repair: A preliminary study of feasibility.","authors":"Sébastien Bloc, Cyril Quemeneur, Cécile Naudin, David Barouk, Guillaume Dufour, Mario Bucciero, Anaelle Fedida, Matthieu Karoubi, Xavier Deloin, Romain Rousseau, Marc Elkaim, Anthony Wajsfisz, Fréderic Le Saché","doi":"10.1053/j.jfas.2025.07.009","DOIUrl":"10.1053/j.jfas.2025.07.009","url":null,"abstract":"<p><strong>Background: </strong>Various anesthetic techniques are available for surgical repair of Achilles tendon rupture. The main limitation of peripheral nerve blocks is the risk of failure that can be attributed to the failure of the \"tourniquet\" block or of the \"surgical\" block.</p><p><strong>Purpose: </strong>This retrospective study assessed the feasibility and the reproducibility of the association of WALANT technique to sciatic nerve block for Achilles tendon repair surgery.</p><p><strong>Study design: </strong>Data from 34 adult patients scheduled for Achilles tendon repair were collected retrospectively from January 2022 to April 2023.</p><p><strong>Methods: </strong>Sciatic nerve block (15 ml of Ropivacaine 0.375 %) and WALANT (30 ml of lidocaine 1 % with epinephrine) were performed under ultrasound guidance 30 minutes before surgery. A pneumatic thigh tourniquet was applied but not inflated. The primary endpoint was the efficiency of the combination of sciatic nerve block and WALANT, defined by anesthetic and hemostasis qualities.</p><p><strong>Results: </strong>Efficacy of the combination of sciatic nerve block and WALANT was 91.2 %: one patient required sedation due to pain during skin incision (percutaneous technique), and two others due to discomfort. The hemostatic quality of WALANT was appropriate in 100 % of cases, no pneumatic tourniquet was required.</p><p><strong>Conclusion: </strong>The combination of sciatic nerve block and WALANT infiltration provides an efficient and reproducible technique for the Achilles tendon repair. It avoids the need for a pneumatic tourniquet and limits the risk of peripheral nerve block failure.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144735027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-year outcomes following triplanar tarsometatarsal arthrodesis with early weightbearing for Hallux Valgus: A multicenter prospective study.","authors":"Daniel J Hatch, Avneesh Chhabra, Mindi Dayton, Paul D Dayton, Daniel C Farber, Deidre A Kile, Jennifer Koay, George T Liu, Jody P McAleer, Robert D Santrock","doi":"10.1053/j.jfas.2025.07.007","DOIUrl":"10.1053/j.jfas.2025.07.007","url":null,"abstract":"<p><strong>Background: </strong>Traditional hallux valgus surgery has been focused on two-dimensional repair with high reported recurrence rates.</p><p><strong>Purpose: </strong>We report the 4-year interim analysis of a prospective, 5-year, multicenter study of radiographic, clinical, and patient-reported outcomes following triplanar first tarsometatarsal arthrodesis with early weightbearing.</p><p><strong>Study design: </strong>This is a prospective, multicenter, clinical trial involving 7 US-based centers and 13 surgeons. One-hundred and seventy-three patients were treated, of whom 139 (80.3%) achieved their 48-month visit. Clinical and radiographic parameters were evaluated at all follow-up visits along with patient-reported outcomes [Visual Analog Scale (VAS), Manchester-Oxford Foot Questionnaire (MOxFQ) and Patient-Reported Outcomes Measurement Information System (PROMIS).</p><p><strong>Methods: </strong>Institutional review board approval was obtained for each study site. A consecutive cohort of patients were enrolled from November 2018 to April 2021 who received first TMT arthrodesis to correct their symptomatic hallux valgus. Inclusion and exclusion criteria were established.</p><p><strong>Results: </strong>Significant improvements in triplanar radiographic correction (hallux valgus angle, intermetatarsal angle, tibial sesamoid position, sagittal-plane IMA, and osseous foot width) were maintained at all timepoints. Using recurrence definitions of > 15° and 20° postoperative hallux valgus angle, recurrence rates were 8.4% (95% CI:4.27%, 14.53%) and 0.8% (95% CI:0.02%, 4.18%) at 48 months, respectively. Mean (95% CI) time to weightbearing in a boot walker was 7.7 (6.6, 8.8) days.</p><p><strong>Conclusion: </strong>The 4-year interim results of this prospective, multicenter study demonstrate favorable improvement of the triplanar hallux valgus deformity, maintenance of correction, low complication rate, and favorable patient-reported outcomes with early return to protected weightbearing.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results of ingrown toenails treated with modified Winograd technique using lateral edge inversion modification.","authors":"Mehmet Ekici","doi":"10.1053/j.jfas.2025.07.011","DOIUrl":"10.1053/j.jfas.2025.07.011","url":null,"abstract":"<p><strong>Background: </strong>Ingrown toenail is a common condition, especially among young individuals, characterized by pain, swelling, redness, and infection. Surgical intervention is often required in stage II and III cases, with the Modified Winograd (MW) technique being the most widely used. Nevertheless, recurrence and infection remain notable concerns.</p><p><strong>Purpose: </strong>To assess whether lateral edge inversion modification added to the MW technique reduces recurrence rates.</p><p><strong>Study design: </strong>Retrospective comparative observational study.</p><p><strong>Methods: </strong>A total of 341 patients treated between January and November 2023 were analyzed. Group 1 (n = 96) underwent MW with lateral edge inversion, while Group 2 (n = 245) underwent MW alone. Demographics, surgical time, infection rates, recurrence, and recovery were compared.</p><p><strong>Results: </strong>The mean age was 25.2 years, with 223 males and 118 females. Surgical time was comparable between groups. Early infection occurred in 4.16 % of Group 1 and 6.53 % of Group 2 (p > 0.05). Recurrence was observed in 10 patients in Group 2 but none in Group 1 (p < 0.05), indicating a significant reduction with lateral edge inversion.</p><p><strong>Conclusion: </strong>Lateral edge inversion modification is a simple and effective addition to the MW technique, significantly reducing recurrence rates in the treatment of ingrown toenails.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint preservation in hallux rigidus: evaluating the efficacy of modified chevron osteotomy with extensive cheilectomy.","authors":"Héctor José Masaragian, Leonel Rega, Fernando Perin, Lucas de Allende, César Miguel Fabrego, Johann Luis Veizaga Velasco","doi":"10.1053/j.jfas.2025.07.006","DOIUrl":"10.1053/j.jfas.2025.07.006","url":null,"abstract":"<p><strong>Background: </strong>Hallux rigidus is a degenerative condition of the first metatarsophalangeal joint, more frequently affecting females and individuals over 40 years. Various surgical options exist, but no prior studies have reported outcomes for distal shortening chevron osteotomy combined with extensive dorsal cheilectomy.</p><p><strong>Purpose: </strong>To evaluate the clinical and functional outcomes of patients with hallux rigidus treated with distal shortening chevron osteotomy and extensive dorsal cheilectomy.</p><p><strong>Study design: </strong>Retrospective case series.</p><p><strong>Methods: </strong>A total of 50 patients (51 feet) underwent surgery between 2015 and 2022. One patient had bilateral involvement. The mean age was 49.37 years; 46 % were male and 54 % female. Mean follow-up was 46.57 months (range, 6-81 months). Patients were assessed preoperatively and after surgery using the American Orthopaedic Foot & Ankle Society (AOFAS) score, range of motion (ROM), Visual Analogue Scale (VAS), and Foot and Ankle Ability Measure (FAAM).</p><p><strong>Results: </strong>Postoperative scores demonstrated statistically significant improvements across all measures. Patients reported decreased pain, improved joint mobility, and enhanced function. The majority expressed satisfaction and indicated a willingness to undergo the procedure again.</p><p><strong>Conclusion: </strong>Distal shortening chevron osteotomy with extensive dorsal cheilectomy is a safe and effective surgical option for Coughlin grades I-III hallux rigidus. This technique yields consistent improvements in pain, mobility, and function, with high patient satisfaction.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic deltoid ligament insufficiency results in greater anterior translation and positive arthroscopic drive-through sign.","authors":"Ryan B Rigby, Sarah J Ingwer, Nathan Ptak, Justin Fleming, Oliver Hauck, Anthony N Khoury","doi":"10.1053/j.jfas.2025.07.005","DOIUrl":"10.1053/j.jfas.2025.07.005","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis and treatment of medial deltoid ligament instability is inconsistent.</p><p><strong>Purpose: </strong>This biomechanical study evaluated arthroscopic drive-through sign as a viable and reproducible diagnostic method to determine chronic deltoid instability and determined the restorative potential of combined medial and lateral ligament repair on ankle stability.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>The proximal tibia (n = 5) was mounted in 20° plantar flexion. Anterior translation was simulated by loading specimens with 2 kg/3 kg/4 kg. Arthroscopic drive-through sign and anterior translation distance were evaluated at the following ligament release and repair phases: intact, lateral instability, dual-sided instability, dual-sided repair, and lateral repair alone. Arthroscopic drive-through was attempted with 2.0-5.0 mm diameter probes before each phase. A positive arthroscopic drive-through sign was defined as passage into the medial gutter.</p><p><strong>Results: </strong>Positive arthroscopic drive-through sign for intact specimens were observed with 2.0 mm (4/5) and 2.5 mm (1/5) probes. In the dual-sided instability model, probe sizes ranged from 3.5 mm to 4.5 mm. Dual-sided repair restored the medial gutter distance to intact. The lateral repair alone did not restore to intact. Anterior translation in dual-sided instability was significantly greater than intact (14.3 ± 1.9 mm[12.6-16.0] vs. 7.4 ± 1.5 mm[6.1-8.7], P < 0.001). Dual-sided repair and lateral repair alone restored intact anterior translation (4.8±0.8 mm[4.1-5.5], P = 0.637; 7.0 ± 1.1 mm[6.0-8.0], P = 0.958).</p><p><strong>Conclusion: </strong>The arthroscopic drive-through sign seems to be a reliable method to detect medial deltoid instability. Combined medial and lateral ligament repair effectively restores anterior translation to intact levels. Medial deltoid repair contributed to 23.2 % of the total anterior translation reduction from the dual-sided instability phase to dual-sided repair phase.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid and its outcomes in foot and ankle surgical procedures: A meta-analysis","authors":"Chad A. Smith DPM, AACFAS ,&nbsp;Jeanie L. Davies MSPH ,&nbsp;Roberto A. Brandáo DPM, FACFAS ,&nbsp;Gregory C. Berlet MD","doi":"10.1053/j.jfas.2025.05.021","DOIUrl":"10.1053/j.jfas.2025.05.021","url":null,"abstract":"<div><div>As the indication for Tranexamic Acid (TXA) evolves, this study serves as a comprehensive review of the literature evaluating the impact of TXA in foot and ankle surgery. Preferred Reporting Items for Systematic Reviews and Meta-Analyses <strong>(</strong>PRISMA) guidelines were followed to evaluate TXA benefits and safety profile in foot and ankle surgery. Inclusion criteria included TXA use in foot and ankle surgery with at least one of the outcomes: wound complications, infections, postoperative bleeding, and risk of thromboembolic events (VTEs). MEDLINE/PubMed and Cochrane Library were searched for eligible studies from inception through April 1st, 2023, utilizing keywords: tranexamic acid with any combination of calcaneal, foot and ankle, total ankle arthroplasty. Risk of bias was assessed by Cochrane Robvis and ROBIN-1 tools. Cochrane Review Manager synthesized individual study data. Of 36 studies reviewed, 7 met inclusion criteria. There was a total of 691 subjects between the two groups: TXA (<em>n</em> = 338) and non-TXA (<em>n</em> = 353). Though statistically not significant, wound complications and postoperative infections were lower in the TXA group compared to non-TXA (15.4 % versus 26.1 %, <em>p</em> = 0.21) and (4.9 % vs. 9.4 %, <em>p</em> = 0.20), respectively. The TXA group experienced statistically lower blood loss compared to the non-TXA group (149 vs. 156 ml, <em>p</em> = 0.002), and showed a lower hemoglobin drop level (122 vs. 138, <em>p</em> = 0.005). TXA use in foot and ankle surgery demonstrated a trend towards lower overall wound complications, risk of infections, risk of postoperative bleeding, with no increased risk for VTEs.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 6","pages":"Pages 827-834"},"PeriodicalIF":1.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fat grafting for pedal fat pad atrophy: A narrative review of the literature","authors":"George Bcharah BS,&nbsp;Sailesh V. Tummala MD,&nbsp;Collin L. Braithwaite MD,&nbsp;Phillip J. Karsen PA-C, MS,&nbsp;Karan A. Patel MD","doi":"10.1053/j.jfas.2025.07.008","DOIUrl":"10.1053/j.jfas.2025.07.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Pedal fat pad atrophy involves the loss of shock-absorbing adipose tissue beneath the foot, causing pain, reduced mobility, and risk of skin breakdown. Autologous fat grafting has gained attention as a regenerative approach that restores natural cushioning rather than merely masking symptoms.</div></div><div><h3>Methods</h3><div>PubMed, Web of Science, and Google Scholar were searched through 02/01/2025 for studies on autologous fat grafting for pedal fat pad atrophy of any etiology. Data regarding pain relief, functional outcomes, complications, and comparisons with orthotics, dermal fillers, silicone implants, and allograft adipose matrix were examined.</div></div><div><h3>Results</h3><div>Autologous fat grafting demonstrated substantial, sustained pain reduction and improved foot function in multiple studies. Randomized trials showed superior outcomes over conservative management, with decreased pain scores and enhanced mobility persisting up to two years post-procedure. Imaging assessments indicated stable or redistributed graft volume correlating with long-term symptom relief. Complications were minimal, typically limited to minor bruising or temporary discomfort. Comparisons revealed that while dermal fillers provide short-term cushioning and silicone implants pose regulatory concerns, allograft adipose matrix also exhibits regenerative effects similar to autologous fat grafting but without donor-site morbidity.</div></div><div><h3>Conclusion</h3><div>Autologous fat grafting effectively addresses pedal fat pad atrophy by restoring lost cushioning and alleviating pain. Its low complication rate, durable outcomes, and regenerative potential position it as a favorable therapeutic option. Longer-term studies comparing autologous to other approaches will refine patient selection, optimize foot pad restoration, and improve outcomes in these populations.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 6","pages":"Pages 835-842"},"PeriodicalIF":1.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of surgical intervention on ankle fractures in octogenarians and nonagenarians: a comprehensive outcome analysis","authors":"Yiyun Lin MD ,&nbsp;Jie Gao MD ,&nbsp;Huayong Zheng MD ,&nbsp;Xiaowei Wang MD ,&nbsp;Tiansheng Sun MMS","doi":"10.1053/j.jfas.2025.06.004","DOIUrl":"10.1053/j.jfas.2025.06.004","url":null,"abstract":"<div><div>This study assesses clinical outcomes and quality of life (QoL) following surgical treatment of fragility ankle fractures in individuals aged over 80 years. We conducted a retrospective study involving 45 elderly patients who underwent surgery for fragility ankle fractures between 2015 and 2023. Pre-operative mobility was assessed using the Parker Mobility Score (PMS), and nutritional status was evaluated using a short-form mini-nutritional assessment (MNA-SF). The ASA classification and the age-adjusted Charlson Comorbidity Index (aCCI) were used to assess comorbidities affecting outcomes comprehensively. Primary outcomes included (1) Ankle function, measured by the Olerud-Molander Ankle Score (OMA-score), and (2) QoL, assessed through the EQ-5D-3 L index score, EQ-VAS, and Barthel Index. Any postoperative complications or mortality were considered secondary outcome. The cohort’s mean age was 83.8 ± 3.2 years. At the one-year follow-up, the OMA-score negatively correlated with pre-operative days (<em>p</em> = 0.035), length of hospital stay (<em>p</em> = 0.047), and time to weight-bearing initiation (<em>p</em> &lt; 0.001). Time to weight-bearing initiation negatively impacted the EQ-5D-3 L index (<em>p</em> = 0.001) and EQ-VAS (<em>p</em> &lt; 0.001), whereas the Barthel Index showed positive correlations with pre-operative PMS (<em>p</em> = 0.005) and MNA-SF (<em>p</em> = 0.002). Surgical and non-surgical complication rates were 28.9 % and 31.1 %, respectively. The one-year survival rate was 75.6 %. Deceased patients had higher aCCI scores (<em>p</em> = 0.005), lower PMS (<em>p</em> &lt; 0.001), and lower MNA-SF scores (<em>p</em> = 0.005); however, the ASA grade showed no significant difference (<em>p</em> = 0.066). The timing of weight-bearing initiation after ankle surgery may significantly influence ankle function and QoL in octogenarians and nonagenarians. Geriatric assessments, such as the PMS, MNA-SF, and aCCI, effectively assess mortality risk, whereas the ASA classification is less predictive.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 6","pages":"Pages 751-756"},"PeriodicalIF":1.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors for the prognosis of pilon variant posterior malleolar fracture: A retrospective study","authors":"Yun Gao PhD, MD ,&nbsp;Yihao Sun MM ,&nbsp;Zhijun Shen MM ,&nbsp;Jinliang Xie MS ,&nbsp;Cheng Chen MM ,&nbsp;Jian Hu MM ,&nbsp;Lei Wang MD","doi":"10.1053/j.jfas.2025.05.016","DOIUrl":"10.1053/j.jfas.2025.05.016","url":null,"abstract":"<div><div>Poor reduction quality in Pilon variant posterior malleolar (PVPM) fractures may lead to articular incongruity, resulting in functional impairment and eventual post-traumatic arthritis. Although intra-articular impacted fragments (IAIF) are frequently observed in PVPM fractures, the clinical necessity of IAIF reduction remains controversial, and the prognostic significance of IAIF presence or malreduction remains unclear. This retrospective study investigated prognostic factors in 64 surgically treated PVPM fractures with 24-month follow-up. Patients were divided into groups based on their reduction quality. Postoperative articular stepping and/or separation ≥ 2 mm were/was considered “poor” reduction, otherwise “optimal or good”. AOFAS is the primary outcome while the VAS pain score, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) are secondary outcomes. Statistical differences of in AOFAS, SF-36 and VAS were observed between reduction quality groups with the optimal reduction showing significantly better outcomes at postoperative 24 months. Statistical difference of AOFAS, SF-36 and VAS was also found between the sex groups with female cases showing significantly poorer outcomes. Neither IAIF’s presence, size, morphological difference or location affected the prognosis. Based on linear regression analysis, “female”, “poor reduction” and “syndesmotic fixation” are categorical variables that impair the functional prognosis of PVPM fractures at postoperative 24 months. This study indicates that the reduction quality based on articular stepping and separation was positively associated with clinical outcomes in PVPM fractures at 24 months postoperatively, which is independent of IAIF. Therefore, regardless of the presence of the IAIF, the reduction quality of the articular congruity positively affects the prognosis of PVPM fracture.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 6","pages":"Pages 743-750"},"PeriodicalIF":1.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}